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UNITED STATES PUBLIC HEALTH SERVICE 

RUPERT BLUE, Surgeon General 



THE FEEBLE-MINDED 

THEIR PREVALENCE AND NEEDS IN THE SCHOOL 
POPULATION OF ARKANSAS 



BY 



WALTER L. TREADWAY 

M 

Assista?it Surgeon, United States Public Health Service 



REPRINT No. 379 

FROM THE 

PUBLIC HEALTH REPORTS 

November 24, 1916 
(Pages 3231-3247) 




l1~JLL/*y 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1916 



Monograph 



ADDITIONAL COPIES 

OF THIS PUBLICATION MAY BE PROCURED FROM 

THE SUPERINTENDENT OF DOCUMENTS 

GOVERNMENT PRINTING OFFICE 

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JAN 18 1917 



!K 






THE FEEBLE-MINDED. 

THEIR PREVALENCE AND NEEDS IN THE SCHOOL POPULATION OF ARKANSAS. 1 

By Walter L. Treadway, Assistant Surgeon, United States Public Health Service. 

In recognition of the fact that the care of the mental defective has 
become quite generally the function of the State, the Fortieth Gen- 
eral Assembly (1915) of Arkansas passed the following concurrent 
resolution : 

That a commission of five persons, residents of this State, shall be appointed 
by the Governor, to investigate the conditions and needs of the feeble-minded 
in the State, the said commission to be known as the Commission for the 
Feeble-Minded. Approved March 25, 1915. 

At the request of the commission thus appointed, and for the fur- 
therance of general investigations of mental and school hygiene, an 
officer of the Public Health Service was detailed to make studies of 
the prevalence of feeble-mindedness in Arkansas for the purpose of 
assisting the commission in determining the needs of the State in 
regard to the feeble-minded. 

Facts Pertaining to Mental Deficiency. 

For many years mental disorders were looked upon with super- 
stitious fear. The insane, therefore, were placed in prisons or other 
institutions, while mentally feeble children and adults were often 
subjected to abuse and neglect or cared for in almshouses and other 
places of confinement where no effort was made to render them useful 
to themselves or to society. 

In 1800, however, an attempt was made by Itard, a physician at 
the National Institution for the Deaf and Dumb at Paris, to educate 
an idiot, " The Savage of Aveyron." Between 1800 and 1848 the care 
and education of the feeble-minded attracted considerable attention 
in France, Switzerland, Germany, and England, where schools for 
this class of individuals were established. 

As early as 1818 the problem of the feeble-minded began to attract 
attention in the United States. During that year several idiots were 
admitted to the American Asylum for the Deaf and Dumb at Hart- 
ford, Conn., and an attempt was made to treat and educate them. In 
1846 a bill for State care of the feeble-minded was introduced in the 

1 Reprint from the Public Health Reports, vol. 31, No. 47, Nov. 24, 1916, pp. 3231-3247. 

3 



4 THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 

New York Legislature. It was defeated, but passed two years later. 
Following this a .private school for the education of the feeble- 
minded was opened at Barre, Mass. 1 By 1870 seven States had made 
some provision for the feeble-minded. These were Massachusetts, 
New York, Pennsylvania, Connecticut, Ohio, Kentucky, and Illinois, 
in the order named. 2 

During the period 1870-1915, 32 States made some provision for 
the care of the feeble-minded, while 10 private institutions for the 
care and training of the underaverage child, each with 50 or more 
beds, were established in 9 different States. 3 

Mental deficiency has been defined as a lack of normal mental 
capacity due to defective development of the brain. While by far 
the greater proportion of those who are mentally defective are so 
because of conditions which existed at birth or because of injuries 
sustained by the brain during birth, it is proper also to include those 
in whom mental development is arrested or retarded by illness or 
injury during the early years of childhood. 

The most widely quoted definition of feeble-mindedness is that 
adopted by the Royal Commission appointed by the English Govern- 
ment in 1901, to investigate the conditions of the feeble-minded in the 
British Isles and is as follows: "The feeble-minded peison is one 
who is capable of earning a living under favorable circumstances, but 
is incapable, from mental defects existing from birth or from an 
early age, of competing on equal terms with his normal fellows or 
managing himself or his affairs with ordinary prudence." 4 

The American Association for the Study of the Feeble-minded 
tentatively adopted the following : " The term feeble-minded is used 
generically to include all degrees of mental defect due to arrested or 
imperfect mental development, as a result of which the person so 
afflicted is incapable of competing on equal terms with his normal 
fellows or managing himself or his affairs with ordinary prudence." 

Witmer does not attempt a full definition in one or two sentences, 
but some idea may be gathered from the following : " The defectives 

1 Institution for the Education of Idiots, Imbeciles, and Children of Retarded Develop- 
ment of Mind. Jan. 1, 1851, pp. 18-19. By Dr. H. B. Wilbur, Barre, Mass. 

It is of interest to note the following from the first report of that institution (1851) 
relative to the purpose for which it was inaugurated. " It aims to nourish and en- 
courage the growth of what may be mere germs of functions and faculties, to direct 
those functions and aptitudes in the natural channels of physical and mental labor, and 
to give to the subjects of it the greatest possible resemblance to children well endowed 
and properly educated. * * * 

" It seeks by the constant and persevering use of every variety of moral means to render 
those newly acquired powers and faculties subservient to an enlightened sense of rela- 
tions to the moral world." 

2 " History of Treatment of the Feeble Minded," by Walter E. Fernald, M. D. Report 
of the Proceedings of the 20th National Conference of Charities and Correction. 

3 Public Institutions for the Feeble Minded and Epileptic in the United States, by 
National Committee for Mental Hygiene, New York. 

■ i Definition by Royal College of Physicians, London. 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 5 

are those who have so many and such severe mental defects that they 
are unable to overcome these defects as a result of expert training and 
must therefore reach adult age arrested in mental and moral develop- 
ment, industrially incapable of earning a modest livelihood and 
socially a menace oftentimes to themselves and their families and 
alwaj's to society, either by virtue of their own behavior or their re- 
tained capacity to reproduce their kind.'* 

The condition of feeble-mindedness varies from the most profound 
degree, in which there is but a glimmer of intelligence, to that in 
which the defect is apparent only in the highest levels of mental 
activity and which is not incompatible with the ability to acquire a 
large store of information nor to earn a living. 

Those engaged in educational work usually prefer a classification 
which is based upon a comparison between the actual age of the per- 
son in question and his " mental age." The average mental develop- 
ment of normal children at different ages has been determined largely 
by various psychological tests, the best known and most widely used 
being the Binet-Simon tests. These tests were devised empirically by 
determining a group of tests which a child of normal mental develop- 
ment for a given age would be expected to pass. They were after- 
wards used for the purpose of grading a group of mental defective 
persons in terms of " mental age " in order that they might be classi- 
fied for purposes of education. These tests have since been modified 
and revised for the purpose of grading in terms of " mental years," 
the mental development of school children, inmates of prisons, re- 
formatories, and other institutions. 

By this method of "mental age" classification the feeble-minded 
have been divided into three groups : Idiots, whose mental age is be- 
low 3 years; imbeciles, whose mental age is between 3 and 7 years; 
and morons, between 8 and 12 years. This classification has been 
adopted by the American Association for the Study of the Feeble- 
Minded. 

In recent years there has been a tendency to include higher and 
higher grade cases in the feeble-minded group. In some instances 
this has resulted in placing persons in environments ill suited to 
them. 

It is a well-known fact that children who are retarded and far 
below the average intelligence at an early period may as they grow 
older catch up a year or two in mental growth. The fact that a 
child grades below the average by formal tests is not an infallible 
sign that he will never develop beyond the mental attainments of a 
child. An analogy is found in the retarded physical development of 
certain children. 

There is good reason for including in the feeble-minded group only 
those children whose mental retardation is not complicated by faulty 



6 THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 

training or physical disorders. In other words, as feeble-mindedness 
is incurable, to place the doubtful feeble-minded group as incurable 
might, in the light of present conditions, stigmatize the child and 
family. Many of these cases resemble the feeble-minded if the sta- 
tistical results of formal tests are taken as a basis for diagnosis. 

There is still another group with a low average normal intelli- 
gence, composed of individuals of poor intellectual development, but 
still regarded as normal — " Not tainted but dull." Mental inferiority 
of this type is more or less a constitutional trait that can not be 
regarded as feeble-mindedness. 

The physical growth of the feeble-minded child is often superior 
to his mental development, so that when he reaches adolescence the 
sad combination of his childish mind and adult body brings him into 
conflict with laws, rules of conduct, and customs of society arranged 
for normal adults. Thus we often find that the feeble-minded are 
delinquent and criminal because they are unable to comprehend laws 
or control their acts. They are easily influenced to commit crime and 
often become the prey of the stronger. They easily acquire vicious 
habits and not infrequently become addicted to alcohol and drugs. 
Incapable of providing for themselves they soon become dependent 
upon charity. 

The feeble-minded are often sexually immoral because they are 
unable to guard themselves against the advances of others or to deal 
with the problem of their own sexual life as the standards of the com- 
munity require. Some of them become perverts and prostitutes. It 
has been shown by recent studies conducted by the United States 
Public Health Service that 19 per cent of the inmates of an institu- 
tion for the care of illegitimately pregnant girls were feeble-minded. 1 
In almost every almshouse in this country may be found a few feeble- 
minded women who have given birth to one or more feeble-minded 
children. Not they alone, but their progeny as well are a burden 
upon the community. 

Although the prevalence of mental deficiency is not known, a num- 
ber of estimates have been made as a result of careful observations of 
different groups of the population. For example, it is estimated 
that 5 to 15 per cent of those confined in prisons, penitentiaries, jails, 
and workhouses are feeble-minded. Wide variations exist as to the 
prevalence of feeble-mindedness in the juvenile delinquent classes. 

Kecent studies conducted by the United States Public Health 
Service have shown that 9 in every 1,000 American rural school 
children are feeble-minded. 2 

1 Not published. 

2 " Rural School Sanitation including Physical and Mental Status of School Children 
in Porter County, Indiana. Public Health Bulletin No. 77." 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 7 

Since the study of the Royal Commission of England (1904) it 
has been assumed that two out of each 1,000 in the general popula- 
tion are feeble-minded. On the basis of this estimate it is likely that 
500,000 feeble-minded persons are present in the United States to- 
day. 

According to the National Committee for Mental Hygiene there 
■were in 1915, 33,474 beds especially provided by the various States 
for the custody and training of the feeble-minded. 1 The existence 
of such a large number of persons who are children in mental attain- 
ments but for the most part men and women in actual years consti- 
tutes a problem of great importance. 

So intimately associated is the problem of mental deficiency with 
crime, poverty, disease, delinquency, immorality, and other social ills, 
that health authorities, educational authorities, and the courts are 
deeply interested in a satisfactory solution. 

Scope of the Survey in Arkansas. 

The relation of mental deficiency to delinquency, dependence, and 
immorality, is vastly more important in the years of adult life than 
in childhood, but the phases of the problem as they present them- 
selves in the years of school life are more readily manageable. The 
school population, therefore, constitutes the larger group to which 
access for satisfactory investigation can be had. 

It was impossible in the time allotted to visit all the schools or to 
examine every child of school age in the State. In order, therefore, 
to strike an average for the State, a number of counties were chosen 
in which to conduct these studies. Certain sociological conditions, 
educational opportunities, and public-health considerations influ- 
enced the selection of the counties to be surveyed. Of these due con- 
sideration was given to their isolation, to the per capita wealth, 
to compulsory school attendance, to literacy, to the percentage of 
native-born population, to the presence of foreign immigration, 
and to a wide prevalence of or freedom from malaria and hookworm 
disease in endemic form. The counties and districts surveyed rep- 
resented each of these conditions or its opposite. 

Great harm has resulted from statements as to the prevalence of 
mental deficiency, which were not based upon actual observation. 
During the course of this survey, therefore, cases concerning which 
there was considerable doubt were not included in the enumeration 
of the feeble-minded. 

Certain phases of the problem of mental deficiency stand in such 
close relationship to school hygiene that it was thought desirable to 

1 Public Institutions for the Feeble Minded and Epileptic in the United States, by 
National Committee for Mental Hygiene, Xew York. 



8 THE FEEBLE-MINDED IN AKKANSAS SCHOOLS. 

include also in these investigations a survey of school environment. 

The results of the latter studies will be set forth in a subsequent 

report. 

Methods Employed. 

As the object of this survey was to determine primarily the 
prevalence of feeble-mincledness in the school population, the plan 
adopted was as follows : 

.In each school visited the children passed the examiner in single 
file to have their eyelids inspected for trachoma. Each child was, 
therefore, personally inspected. During the course of this primary 
inspection a certain group of children was selected for further in- 
quiry regarding mental development. Their general manner and 
conduct of approaching the problem of having their eyes inspected, 
their gait, and manner of adjusting themselves to the new situation, 
served as a guide to selection of a group for further inquiry. The 
facial expression, stigmata, and general reaction in the emotional 
field, overage, character of physical development or abnormalities 
also played a part in their selection. 

In addition, the teacher was asked to select the children who ap- 
peared slow, stupid, peculiar, underaverage in mental attainments, 
or who had difficulty, for any reason whatsoever, in doing classwork. 
The subsequent examination of these children showed that many of 
them were not retarded. 

In order to see in a short time a large group of children representa- 
tive of a community, it is necessary to adopt some rapid method and 
the plan outlined above seems to be practical and consistent with ac- 
curacy. It not only lends the weight of one who has had some experi- 
ence with the underaverage and normal child, but is supplemented by 
the opinion of the teacher who has had an opportunity of observing 
from day to day and, in some instances, from year to year, the mental 
adjustment during the growth of the child. 

Each child so selected was graded according to the Binet-Simon 
scale of grading intelligence. Arbitrary standards, based upon the 
statistical results of this scale, however, have resulted in classifying 
children as feeble-minded when such is far from being true. The in- 
dividual approach to the diagnosis of feeble-mindedness is the one to 
be recommended, rather than that based upon statistical standards 
of the results of a series of psychological tests. Individual approach 
must include some knowledge of the child's environment, heredity, 
presence of disease, stigmata, the general emotional reaction, his 
grasp of the situation, his general knowledge, his adjustments, and 
his method of arriving at conclusions, all of which are significant in 
the diagnosis of feeble-mindedness. This method, supplemented by 
formal tests, is conservative and accurate. 



THE FEEBLE-MINDED IN" ARKANSAS SCHOOLS. 9 

Prevalence of Feeble-Minded in the Rural Districts Visited in Thirteen 

Counties of Arkansas. 

Fifty-one rural schools were visited in 13 counties during this sur- 
vey. Of this number, 9 were one-room schools and 42 were of more 
than one room. 



Table 1. 



-Showing percentage of feeble-minded children in rural schools visited 
in Arkansas. 



Num.- 

Counties. Lg^J, 

i visited. 


Num- 
ber of 
boys 
exam- 
ined. 


Num- 
ber of 
girls 
exam- 
ined. 


Num- 
ber of 
feeble- 
minded 
boys. 


Num- 
ber of 
feeble- 
minded 
girls. 


Num- 
ber of 
both 
sexes 
enrolled 

in 
schools 
visited. 


Per 
cent of 
attend- 
ance. 


Per 
cent of 
feeble- 
minded 
boys. 


Per 
cent of 
feeble- 
minded 

girls. 


Per 
cent of 
feeble- 
minded 

both 
sexes. 


Benton 

Columbia 

Clark 


6 
4 
4 
3 
4 
5 
4 
4 
4 
3 
4 
3 
3 


241 
324 
362 
296 
196 
114 
256 

66 
298 

68 
128 

80 
239 


272 
358 
373 
234 
213 
111 
289 

87 
339 

85 
129 
105 
238 


2 
2 
3 
2 
2 
4 
5 
1 
2 


2 
3 
3 
3 


513 
1,087 
837 
770 
505 
434 
824 
154 
807 
200 
465 
258 
832 


100 
71 
87 
68 
80 
51 
66 
99 
78 
76 
53 
71 
57 


0.8 

.6 

.85 

.67 
1 

3.5 
1.9 
1.5 

.67 


0.73 
.5 
.8 

1.2 


0.77 
.51 
.83 
.94 


Chicot 


.48 


Garland 


1 

2 


.9 
.6 


2.2 
1.2 




.65 


Little River 

Miller 


1 
1 


.29 
1.1 


.47 

.6 


Polk 




















Sebastian 


1 


1 


.4 


.4 


.42 


Total 


51 


2,668 


2,832 


24 


17 


7,905 




.89 


.6 


.74 



Referring to Table 1, it will be observed that the percentage of 
feeble-mindedness varied from none to 3.5 per cent of the boys and 
from none to 1.2 per cent of the girls. Of two counties, namely, 
Polk and Pulaski, where no feeble-minded children were found, one 
had a compulsory school-attendance law and the other had not. In 
the county requiring compulsory school attendance 53 per cent of the 
children were present at the time the schools were visited, and in the 
county which did not require compulsory school attendance 71 per 
cent of the total enrollment was present. It is evident, therefore, 
that the percentage of feeble-mindedness is either very low in these 
counties or else such children did not attend school. The latter 
assumption is probably correct. 

In Jefferson County, with county supervision but without a com- 
pulsory school-attendance law, 99 per cent of the children attended 
school and no feeble-minded girls were found. 

In Chicot County, without county supervision, no feeble-minded 
girls were observed, although SO per cent of the total enrollment 
was present on the day of inspection. 

The highest percentage of feeble-mindedness among the boys in 
the schools visited was observed in Garland County, which had both 
a compulsory-attendance law and county supervision. The per- 
71059°— 16 2 



10 



THE FEEBLE-MINDED IN" ARKANSAS SCHOOLS. 



centage of feeble-mindedness among the girls was also relatively 
high. The highest percentage of feeble-mindedness among the girls 
was found in Clark County, which had neither a compulsory school- 
attendance law nor supervision, although the attendance was 68 per 
cent of the enrollment. 

Unfortunately, the data relative to the nativity of the children ex- 
amined was so meager and unreliable that it was impossible to draw 
conclusions as to the relationship of domestic and foreign immigra- 
tion to the number of feeble-minded in the school population. In 
general, the rural districts of Polk County are affected more heavily 
by domestic immigration than are similar districts in Garland 
County. 

The varying sociologic and economic conditions in the districts 
visited warrant conclusions as to the proportion of feeble-mindedness 
in the rural school population of the State but not for the purpose of 
comparing one county with another. 

The enrollment in the 51 rural schools visited was 7,905, of which 
number 5,500 (2,668 boys and 2,832 girls) were present and inspected. 
Of these, 24 boys, or 0.89 per cent, and 17 girls, or 0.6 per cent, com- 
prising 0.74 per cent of the rural school population examined, were 
feeble-minded. 



Prevalence of the Feeble-Minded in the Urban Districts of Arkansas. 

A glance at Table 2 will show that of the 8,225 children (4,189 
boys and 4,036 girls) examined in the urban districts of Arkansas, 
52 (28 boys and 24 girls) were found to be mentally defective. The 
percentage ranges from 0.37 to 0.9 per cent. The percentage of 
feeble-minded in this group of the population should be somewhere 
between these two extremes. The average for the 20 urban schools 
visited is 0.63 of 1 per cent. 

Table 2. — Showing Percentage of feeble-minded children in the urban districts 

of Arkansas. 



City. 


Num- 
ber of 
boys 
exam- 
ined. 


Num- 
ber of 
girls 
exam- 
ined. 


Num- 
ber of 
feeble- 
minded 

boys. 


Num- 
ber of 
feeble- 
minded 
girls. 


Num- 
ber of 
both 
sexes 
enrolled 

in • 
schools 
visited. 


Total 
enrolled 
first to 
eighth 
grades 
1915- 
1916. 


Per 
cent of 
feeble- 
minded 
boys. 


Per 
cent of 
feeble- 
minded 
girls. 


Per 
cent of 
feeble- 
minded 
both 
sexes. 




1,596 
1,087 
482 
383 
146 
218 
189 
88 


1,522 
1,004 
465 
373 
137 
234 
200 
101 


8 
11 
4 
2 

1 
1 
1 


4 
8 
5 
3 
1 
2 
1 


3,327 
2,171 
1,010 
804 
337 
440 
509 
410 


5,828 

3,281 

2,531 

2,400 

1,200 

440 

509 

410 


' 0.5 
1.0 

.85 
.52 

.46 
.52 
1.1 


0.26 
.9 
1.0 

.8 
.72 
.85 
.5 


0.37 


Fort Smith 


.9 




.9 


Pine Bluff 


.66 




.7 




.6 




.5 




.5 






Total 


4,189 


4,036 


28 


24 


9,008 


16,599 

















THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 11 

Problematical or Border-Line Feeble-Minded Cases in the School Population. 

Since retardation may be due to physical diseases, faulty methods 
of training, and influences of environment, children who are retarded 
as much as three years according to formal tests alone can not be 
classified as feeble-minded. Children of this type are regarded as 
doubtful cases of feeble-mindedness, which require correction of 
physical defects, special instruction, training, and observation over- 
extended periods before a definite diagnosis can be made. Some of 
them become normal, while the rate of mental development of others 
continues slow as the higher chronological ages are reached. 

Unfortunately there is no method of ascertaining the length of 
time required for a child to overcome his mental retardation after 
the defects have been corrected. 

Of 4,189 boys inspected in the urban schools, 22 were border-line 
cases; and of 4,036 girls inspected, 13 were observed whose future 
mental development could not be foretold, but who were regarded as 
border-line cases. In other words, 0.52 per cent of the boys and 
0.32 per cent of the girls were in need of specialized training, al- 
though the term feeble-minded could not be applied to them as the 
result of one examination. 

Of the 22 boys whose future mental development is a matter of. 
doubt, 9 were poorly nourished and below par physically, 1, al- 
though well nourished, was undersized to such an extent that his 
chronological age was questioned, 1 had chronically diseased ton- 
sils, and 1 had a marked post-nasal obstruction. Of the 13 girls 
who were doubtful as to outcome, 2 had very defective vision, 2 
had enlarged and chronically diseased tonsils, 1 had post-nasal ob- 
structions, and the nutrition of 2 others was poor. 

In the 42 rural schools having more than one room, 10 boys of 
2,512 examined and 9 girls of the 2,658 examined were regarded as 
border-line cases, varying from none to 1 per cent of the boys and 
from none to 2.5 per cent of the girls — an average of 0.39 per cent 
of the boys and 0.33 of the girls for the total number examined. 
In other words, 0.36 per cent of the children examined in these 
schools were border-line cases. 

Of the 10 boys of doubtful mental development, 2 were much 
undersized. One, although not retarded to a marked degree, had a 
feeble-minded sister, and 1 who was retarded to a slight degree had 
a feeble-minded brother. 

Of the girls who were doubtful as to outcome, one was too large for 
her chronological age, the mother of another was an epileptic, and 
one, retarded in slight degree, had two feeble-minded brothers. 

In 9 one-room schools having an enrollment of 516 children, with. 
156 boys and 174 girls attending, 3 boys and 1 girl were doubtful as 



12 THE FEEBLE-MINDED IE" AEKANSAS SCHOOLS. 

to outcome. Of these, 2 came from very poor environments and had 
chronically diseased tonsils, and 1 began school late and came from 
a very poor environment. The percentage of border-line cases in 
the one-room schools was 1.9 per cent of the boys and 0.5 per cent of 
the girls, an average of 1.2 per cent. 

Of the 5,500 children (2,668 boys and 2,832 girls) examined in the 
rural districts, 13, or 0.48 per cent, of the boys and 10, or 0.35 per 
cent, of the girls, or 0.4 per cent of the total examined, were regarded 
as border-line cases. 

The undue retardation exhibited by the above-mentioned children 
is the determining factor in the classification. In view of the fact 
that only 0.36 per cent of the children attending the better class rural 
schools, in contrast with 1.2 per cent of those attending the one-room 
rural schools, were so classified, suggests the possibility that these 
border-line cases may be cases of simple retardation due to faulty 
teaching methods or poor environment rather than to an inherent 
mental defect. 

Proportion of Feeble-Minded in the School Population of the State of 

Arkansas. 

The prevalence of feeble-mindedness in the rural districts is high 
in both Grant and Garland Counties. In the urban districts of 
Garland County it is higher than in other urban districts of the 
State. The distribution of mental defectiveness in the combined 
urban and rural districts of the State varied from 0.18 per cent to 
1.5 per cent in the counties surveyed. Of 13,725 children examined, 
93, or 0.67 per cent, are definitely feeble-minded. 

As the districts visited are believed to be representative of the 
varied social and economic conditions of the State and to embrace 
a representative population, the determination of 67 feeble-minded 
children in every 10,000 school children of the State is considered as 
representative of the prevalence of this condition. 

The existence of 67 feeble-minded children in every 10,000 is not 
an overestimate because of the presence of border-line cases. These 
were observed in the proportion of 40 in every 10,000 of the school 
population. Furthermore, the lower grade feeble-minded cases do 
not attend public schools. Especially is this true in the case of 
idiots and low-grade imbeciles who do not attend school because of 
the lax enforcement of the compulsory school attendance law result- 
ing from an incomplete school census. 

According to the 1910 census report, there were in Arkansas 345,282 
white children between the ages of 6 and 14 years. In 1910, 
241,938, or 70.1 per cent, of these were attending the public schools. 
In 1913 (last report of State board of public instruction) there were 
317,386 white children enrolled in the schools of Arkansas. Of this 



THE FEEBLE-MIXDED IX ARKANSAS SCHOOLS. 13 

number 208,490, or 62 per cent, were attending school. Based on the 
results of this survey and the attendance in 1913, there are not less 
than 2,100 of the white children who are feeble-minded. Calculated 
upon basis of the 1910 census report, not less than 2,200 of the white 
children between the ages of 6 and 14 years are definitely feeble- 
minded. 

The mortality rate among the feeble-minded is high. This is 
probably clue to failure to understand the principles of personal 
hygiene, and to irregular employment, improvidence, and bad hous- 
ing. Clark, 1 in the study of 1,000 feeble-minded children, showed 
that the greatest number died under 25 years of age, 30 lived to be 
over 35, 17 to be over 40, and only 4 over 50 years of age. 

Clark and Stowell, 1 during a period of nine years (1903 to 1911), 
cared for 4,275 patients, 2,6G7 classified as feeble-minded and 1,G08 
as idiots. Of the first group, 184, or 6.5 per cent, died. Of the second 
group, 316, or 19.6 per cent, died. During the same period, at the 
same place, the mortality rate among 8,000 children mentally normal 
was 3.38 per cent. These authors conclude that low mental develop- 
ment coincides with low physical stamina. 

According to Clark and Atwood, one-fifth of the children who 
are feeble-minded die in less than one year. Among 200 feeble- 
minded children Atwood found 20 per cent with positive Wasserman 
reaction, although syphilis was not recognized as a factor in any of 
the deaths. If it be true that the mortality rate is unusually high 
in this group of the population, it is likely that 30 in every 10,000 
of the general population are feeble-minded. 

In 1915 the estimated white population of Arkansas was 1,229,987. 
According to this estimate the present survey would show that there 
are 3,600 persons in the general population of the State of Arkansas 
who are definitely feeble-minded. 

Evidence is accumulating to show that heredity is a prominent 
factor in mental deficiency. It is estimated from careful observations 
that 65 per cent of feeble-mindedness is inherited. If it be considered 
that 50 per cent of feeble-mindedness in Arkansas is due to defective 
ancestry, there are at least 300 families in that State whose progeny 
will be feeble-minded. One family in every 300 is composed of po- 
tential criminals, dependents, disseminators of disease, and is an 
economic loss to the communit}^ in which it lives. 

Prevalence of Retarded Children Exclusive of the Feeble-Minded and Border- 
line Feeble-Minded in the Schools of Arkansas. 

Retarded children are found in every large school system. The 
teachers, as a rule, recognize many children who do not profit by the 

1 " Feeble Minded and Idiots, a Study of the Mortality of Four Thousand." By Clark 
and Stowell. N. Y. Med. Jour., Vol. XCVII, 2-22-13, p. 376. 



14 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 



usual course of study. The following table gives the per cent of 
retarded children in urban districts who require the correction of 
physical disorders and faulty methods of training before they will be 
able to compete on equal terms with the average normal children. 

In the rural districts those who require special training and medi- 
cal attention range from none to 2.5 per cent of the boys and none 
to 3 per cent of the girls in the schools visited. Of the 2,668 boys 
examined in the rural districts 49, or 1.8 per cent, were retarded. 
Of the 2,832 girls examined in the rural districts 45, or 1.6 per cent, 
were retarded. 

Of the 49 boys of the rural schools who were retarded, 1 was poorly 
nourished, 1 had adenoids, 1 had diseased tonsils and adenoids, 2 
had speech defects, 2 had epilepsy, i had had an attack of typhoid 
fever, since which he had been very dull mentally. Of the 45 girls 
who were retarded 3 had defects of vision, 4 were very poorly nour- 
ished, 3 had had recent malarial paroxysms and were probable ma- 
larial carriers, and 2 had diseased tonsils. 

Table 3. — Showing percentage of retarded children in urban districts exclusive 
of feeble-minded and border-line cases who do not profit by usual course of 
study. 



Cities 



Number 
of re- 
tarded 
boys. 



Per cent 
boys re- 
tarded. 



Number 
of re- 
tarded 
girls. 



Per cent 
girls re- 
tarded. 



Little Rock . . . 
Fort Smith... 

Hot Springs 

Pine Bluff 

Texarkana 

Arkadelphia. . 
Siloam Springs 
Mena 

Total... 



62 



1 

1.5 

29 

.7 
1.3 

.9 
2.1 
4 



1.4 



53 



0.5 
1.1 
1.7 
3.2 
3.6 
1.2 
1.5 



1.3 



Of the 62 boys in the urban districts who were retarded and unable 
to profit by the usual course of study, 3 had defects of vision, 2 had 
defects of hearing, 5 had adenoids, 1 was very anemic, 1 had epilepsy, 
1 was a " shut-in personality," 1 began school late in life, 1 had cleft 
palate, 4 had speech defects, 1 was a deaf-mute, 4 were dependent and 
had suffered privation, and 1 was delinquent. 

Of the 53 girls who were retarded and unable to profit by the usual 
course of study, 1 had defects of vision, 1 defects of hearing, 1 had 
adenoids, 2 had enlarged and diseased tonsils, 1 had adenoids and 
enlarged tonsils, 4 were very anemic (3 of whom had had recent ma- 
larial paroxysms) , 1 had a " shut-in personality," 1 had chorea, 2 were 
victims of poverty, and 3 were delinquent. 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 



15 



Physical Disorders of Children Not Definitely Retarded But Who Were 
Slower Than the Normal. 

Children who are handicapped by physical disorders should have 
these corrected in order to secure the maximum efficiency. In the 
urban districts, 223 boys and 171 girls were slow, but not definitely 
retarded. Of this number 43, or 19.2 per cent of the boys, and 27, or 
15.8 per cent of the girls, had some physical disorder which poten- 
tially made them candidates for the special classes. 

In the following table is given the percentage of physical disorders 
in the boys and girls of the urban districts who were slow in their 
school work. 

Table 4. — Physical disorders of underaverage children in urban districts of 

Arkansas. 





Boys. 


Girls. 




Boys. 


Girls. 




3.1 

2.6 

.4 

.8 
4.8 


1.7 
1.7 




0.8 
2.6 
1.7 
1.3 




Tonsils enlarged and diseased . 


Anemic 


2.3 
2.8 










4.6 




2.3 











Of the 2.6 per cent boys who were anemic 1.3 per cent had had 
recent malaria and were probably carriers. Of the 2.3 per cent girls 
who were anemic 1.7 per cent had had recent malaria. 

Of the 2.3 per cent girls who had some form of paralysis 1.7 per 
cent of the cases were due to poliomyelitis. 

In the rural districts visited, 162 boys and 125 girls were slow 
in their school work, but were not regarded definitely retarded. 
Thirty-one, or 19 per cent, of the boys and 15, or 12 per cent, of the 
girls had some physical disorder. 

In the following table is given the percentage of plrysical dis- 
orders observed in the boys and girls in the rural districts who were 
slow in their school work, but not definitely retarded. 

Table 5. — Physical disorders of underaverage children in rural districts of 

Arkansas. 





Per cent 
boys. 


Per cent 
girls. 




Ter cont 
boys. 


Per cent 
girls. 




2.4 
3 

.6 
2.4 
5.5 


1.6 

.8 
.8 


Undersized and underweight. 


4.9 
.6 
.6 




Tonsils enlarged and diseased. 












3.2 




4.8 






.8 













Of the 3.2 per cent girls who are anemic 1.6 per cent or half had 
had recent malaria. 



16 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 



Table G.—Slioicing percentage of total children examined who require special 

training. 



City. 



Little Rock 
Fort Smith. 
Hot Springs 
Pine Bluff. . 
Texarkana.. 



Per cent 
boys. 



1.8 
3.2 
4.1 
2.3 

2.7 



Per cent 
girls. 



1.2 
2.1 

3.4 
4.2 
4.3 



City. 



Arkadelphia. . . 
Siloam Springs 

Total.... 



Per cent 
boys. 



1.8 
2.5 
5.2 



Per cent 

girls. 



2.5 

2.5 

.9 



2.4 



In the urban districts, 7.2 per cent of 8,225 children were given the 
benefit of individual and intensive inquiry. Of 5,500 rural school 
children examined 9 per cent were given individual and intensive in- 
quiry. Of the 5,500 children examined in the rural districts 2.8 per 
cent are unable to profit by the usual course of study. 

What Has Been Done in Arkansas to Provide Special Instruction for the 

Underaverage Child. 

It will be observed in Table 6 that the percentage of underaverage 
children is lowest in Little Rock, where a summer school is provided 
for the children who fail to make grade. This city also provides one 
special class for exceptionally backward children. The summer 
school must certainly play some part in lessening the number of cases 
of retardation. The special class in this city for exceptionally back- 
ward children is a step in the right direction. The equipment of the 
building is poor. These children should have the benefit of work- 
ing under the best possible conditions. Good tools and proper sur- 
roundings add not only to industrial efficiency but to the efficiency of 
children in their school work. Little Eock is the only city in the 
State where special classes for children of this type are provided. 

Discussion and Recommendations. 

Care of the feeble-minded. — The proper segregation of the feeble- 
minded by the State will add in future years to the welfare of each 
and every community. At present many cases of feeble-mindedness 
are housed in the State institutions for the insane. The per capita 
cost for caring for the insane in this country varies from $150 to $250 
per annum. In the case of feeble-minded persons who are cared for 
in institutions for the insane, no attempt is made to train them and 
no good opportunity is presented whereby they may be made to pay 
for their support. In the better regulated American institutions for 
the feeble minded, an attempt is made to train this class of individuals 
so that they may be in a measure self-supporting. 

The authorities of the State Hospital for Nervous Diseases at 
Little Rock estimate that not less than 100 of the inmates are feeble- 
minded who will always be a burden upon the Commonwealth either 
inside or outside the institution. With a per capita cost of $200 per 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 17 

annum, $-20,000 is annually expended for their care. These cases 
occupy beds which are intended for the insane and at a greater cost 
than in an institution especially provided for their care. 

The feeble-minded are unable to follow regular employment and 
therefore add to the number of "floating" or irregular employees. 
Owing to their tendency to become criminals and paupers, and to 
their inability to comprehend the principles of right living and per- 
sonal hygiene, this group of individuals forms a large proportion of 
the penal population and adds materially to the spread of communi- 
cable diseases. From an economic, sanitary, and sociological stand- 
point the State of Arkansas should provide an institution for the 
segregation, care, and training of its feeble-minded. 

Children who require individual care and recasting of educational 
methods. — It is believed that the recasting of educational methods 
will serve a true purpose in mental hygiene. Certain individuals 
who, by reason of an inability to adjust themselves to unusual condi- 
tions, are failures because they attempt tasks for which they are but 
poorly fitted by reason of improper training in early life. 

The underaverage child in the regular classes does not profit by 
the usual courses of study. His presence demands extra attention 
from the teacher that might better be devoted to the children of 
normal intelligence. Children who lag in class work tend to prevent 
normal children from advancing as rapidly as they are otherwise 
capable of doing. 

Organization of special classes. — It is essential to know the num- 
ber of retarded and mentally defective children in a community be- 
fore the organization of special classes can be accomplished. Opinions 
differ as to the best way to organize such classes. In general, it is 
good policy to place the decision in the hands of the supervisor of 
special classes and permit her to effect an organization in accordance 
with her own knowledge of local needs and local difficulties. Some 
authorities regard each special class as a diagnosis station as well as 
a place for special training. Others advise the establishment of a 
central class for diagnosis and classification, and that the children 
should be admitted to the special classes only after a period of ob- 
servation in the central class to determine the degree of mental defect 
and capacity to receive training. 

The great advantage of the former plan is that each class will have 
a constant inflow and outflow which tends to prevent the rather hope- 
less attitude that sometimes exists in these classes, while at the same 
time it adds much to the experience and training of the teachers who 
are to devote themselves to this work, It is the experience of every 
city in which special classes have been established that nearly as many 
children go back from the observation class to the regular classes 



18 THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 

after the correction of some physical defect or the use of some special 
methods of instruction as remain in special classes during their 
school life. The children who return to the regular classes are not 
mentally defective. It is a point not to be forgotten that mental de- 
ficiency is not a curable condition, and that the function of the special 
class is not to attempt to make mentally defective children normal, 
but to fit them to be happier and more useful even though handi- 
capped by a defect that can not be removed. 

It would seem desirable in cities to establish the first special class 
at the city training school, if there be one, and to use it for both a 
diagnosis and classification station and a class for special training. 
It should contain not more than 15 pupils, and pupil teachers should 
be assigned to assist the supervisor. Thus the first class will form a 
clinic, in which those who are to undertake work in classes formed 
subsequently may be trained. A number of these pupil teachers who 
pass through this class develop qualifications needed for this work 
and, what is of greater importance, a sincere interest in its aims that 
is essential in all those who are successful in this field of pedagogy. 

Every facility should be given teachers who take up this work to 
increase their information and experience. Visits to the State insti- 
tutions and summer work at one of the many excellent schools which 
give special instruction in the subject of mental deficiency should con- 
stitute features in their training. 

The adoption of such a program by a progressive city needs no 
defense at the present time. There are but few cities in which steps 
are not being taken to organize this work. Some of the results will 
be immediate and striking and some will be remote but none the less 
important. 

Among the first results will be the immediate relief experienced by 
all the regular classes. Many hours that teachers now devote to 
pupils with defective brains will be available for the better instruc- 
tion of normal children. Many children who are not mentally defec- 
tive but who have faulty habits of work, dependent upon early de- 
fects, or training, or physical disturbances, will have their mental 
processes carefully studied by modern scientific methods and will be 
enabled to return to the regular classes with defects corrected and 
latent mental resources liberated. The mentally defective children 
will be placed in an environment in which they are not misfits and in 
which they can be trained to the limits of capacity which their mental 
defects impose. In some cases they will be trained for happier and 
more useful lives in the community ; in others they will be fitted for 
the institutional life which all States must sooner or later provide for 
children who can never take up the tasks and responsibilities of 
adult life. 



THE FEEBLE-MINDED IN ARKANSAS SCHOOLS. 19 

One of the most necessary factors in dealing effectively with the 
problem of mental deficiency in the schools is an adequate school 
census. Such a census is indispensable as a basis for the enumeration 
of the mentally defective and to determine the relation of mental 
deficiency to truancy and other forms of juvenile delinquency. 

Medical inspection of school children. — The medical inspection of 
school children should not only act to prevent the spread of com- 
municable diseases, but serve also to discover the children who re- 
quire correction of physical disorders. Children with physical dis- 
orders are potential candidates for the special classes. Not only 
are they slow but they often fail to make grades. 

This survey has shown that there are 327 boys and 237 girls, ex- 
clusive of the feeble-minded, who are either borderline cases or re- 
tarded cases, or are slow in school work. Thirty-one per cent of 
these boys and 29.6 per cent of these girls have some physical dis- 
order. Of the 221 boys and 179 girls who are border-line and defi- 
nitely retarded cases, 16.3 per cent of the boys and 13.3 per cent of 
the girls have some physical disorder. It is not assumed that these 
physical disorders are the sole cause of retardation, but they are an 
added handicap that plays no small part in preventing them from 
working with maximum efficiency. 

The time lost from school and the repetition of school work from 
year to year not only illy fits these children for future life work, 
but adds materially to the cost of education. 

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